Bayesian mapping of pulmonary tuberculosis in Antananarivo, Madagascar

<p>Abstract</p> <p>Background</p> <p>Tuberculosis (TB), an infectious disease caused by the <it>Mycobacterium tuberculosis </it>is endemic in Madagascar. The capital, Antananarivo is the most seriously affected area. TB had a non-random spatial distribution in this setting, with clustering in the poorer areas. The aim of this study was to explore this pattern further by a Bayesian approach, and to measure the associations between the spatial variation of TB risk and national control program indicators for all neighbourhoods.</p> <p>Methods</p> <p>Combination of a Bayesian approach and a generalized linear mixed model (GLMM) was developed to produce smooth risk maps of TB and to model relationships between TB new cases and national TB control program indicators. The TB new cases were collected from records of the 16 Tuberculosis Diagnostic and Treatment Centres (DTC) of the city from 2004 to 2006. And five TB indicators were considered in the analysis: number of cases undergoing retreatment, number of patients with treatment failure and those suffering relapse after the completion of treatment, number of households with more than one case, number of patients lost to follow-up, and proximity to a DTC.</p> <p>Results</p> <p>In Antananarivo, 43.23% of the neighbourhoods had a standardized incidence ratio (SIR) above 1, of which 19.28% with a TB risk significantly higher than the average. Identified high TB risk areas were clustered and the distribution of TB was found to be associated mainly with the number of patients lost to follow-up (SIR: 1.10, CI 95%: 1.02-1.19) and the number of households with more than one case (SIR: 1.13, CI 95%: 1.03-1.24).</p> <p>Conclusion</p> <p>The spatial pattern of TB in Antananarivo and the contribution of national control program indicators to this pattern highlight the importance of the data recorded in the TB registry and the use of spatial approaches for assessing the epidemiological situation for TB. Including these variables into the model increases the reproducibility, as these data are already available for individual DTCs. These findings may also be useful for guiding decisions related to disease control strategies.</p

Mapping the medical outcomes study HIV health survey (MOS-HIV) to the EuroQoL 5 Dimension (EQ-5D-3L) utility index

10.1186/s12955-019-1135-8Health and Quality of Life Outcomes1718

Mass Media Exposure and Women's Household Decision-Making Capacity in 30 Sub-Saharan African Countries: Analysis of Demographic and Health Surveys.

BackgroundWomen's household decision-making capacity is an essential component of their empowerment which include decisions related to personal health care, large household purchase and family visitations. Despite research evidence acknowledging mass media's influences on women's empowerment, including their ability to take household decisions, empirical data through multi-country comparison on mass media exposure and women's decision making capacity are sparse. This study sought to assess the association between exposure to mass media (television, radio and newspaper/magazine) and women's household decision-making capacity in 30 countries in sub-Saharan Africa (SSA).Materials and methodsData from current Demographic and Health Surveys (DHS) conducted in 30 countries in SSA from January 1, 2010 to December 31, 2016 were used. Binary Logistic Regression analysis was used to assess the association between mass media exposure and women's household decision-making capacity in SSA. Results were presented using crude odds ratios (COR) and adjusted odds ratios (AOR).ResultsWomen who watched television almost every day had higher capacity to take household decisions, compared to those who did not watch television at all. Women who read newspaper/magazine less than once a week were less likely to take household decisions compared to those who never read newspaper/magazine. However, there was no association between exposure to radio and household decision-making capacity. Regarding the covariates, age, level of education, wealth index, occupation, and parity showed significant associations with women's household decision-making capacity.ConclusionFindings stressed the positive contribution of mass media in enhancing women's household decision-making capacity in SSA. Viewing television, a model of mass media, is a very powerful conduit to enhance the household decision-making capacity of women. The use of mass media, especially television in communicating the relevance and ways of achieving household decision-making capacity for all women in SSA is paramount and perhaps, in other low and middle-income countries of the world. Interest groups that require greater attention are women with less exposure to television as well as women in their early reproductive age, the poor, women who are not working and rural residents

Characterization of ready-to-eat baby foods based on fermented African rice

Rice is a staple in most West African countries and an attractive ingredient for a number of food products as a result of its bland taste, hypoallergenicity, availability, and high digestibility. In this frame, this project aimed at the characterization of a ready-to-eat baby food, based on either milled or parboiled local Togo Marshall rice that was fermented for various times (0, 12, 24, and 48 hours) in the presence of alpha-amylase. The properties of the resulting products were addressed by instrumental sensory analysis and by a combination of physico-chemical, rheological and molecular approaches. Electronic nose gave significantly different responses only in the case of milled rice-based sample fermented for 48 hours, whereas electronic tongue discriminated between samples from either milled or parboiled rice, being these latter more astringent and bitter. An effect of the rice parboiling and of the fermentation time on the baby food properties was also highlighted by the WAI and the WSI. As expected, pH and titratable acidity correlated well with the fermentation time. As for the pasting properties, investigated by microviscoamylograph, parboiled rice-based products show a lower viscosity both when heated-up and cooled-down, as a result of the starch gelatinization occurred during the parboiling process. A viscosity increase during fermentation - most likely due to the synthesis of exopolysaccharides by lactic acid bacteria - was evident only in milled rice-based samples. As for molecular approaches, protein aggregation studies indicate that the amount of soluble proteins clearly decreases at higher fermentation times, suggesting the degradation of proteins into peptides. In particular, most of protein hydrolysis events are completed after 12 hours fermentation in the case of milled rice, whereas peptide release is much slower in parboiled rice-based samples. Fermentation also resulted in a slight decrease in the amount of accessible thiols only in the case of milled rice-based samples. Rice parboiling resulted also in significant differences as for the free sugars content in the various products during fermentation. However, pre-treatments had no peculiar influence on the predicted glycemic index. The application of a multidisciplinary approach to the characterization of differently fermented rice-based food contributed to address the quality parameters of the samples. Differences among samples can be related to rice pretreatment before fermentation, that was carried out in the presence of enzymes. This information can offer some guidelines as for designing specific African low-grade rice- based baby foods with peculiar nutritional properties

Investigating a psychological model of mental conditions and coping during the COVID-19 pandemic driven by participatory methods

BACKGROUND: There is evidence of increased mental health problems during the early stages of the COVID-19 pandemic. We aimed to identify the factors that put certain groups of people at greater risk of mental health problems. METHODS: We took a participatory approach, involving people with lived experience of mental health problems and/or carers, to generate a set of risk factors and potential moderators of the effects of COVID on mental health. An online cross-sectional survey was completed by 1464 United Kingdom residents between 24th April and 27th June 2020. The survey had questions on whether respondents were existing mental health service users and or carers, level of depression (PHQ9) and anxiety (GAD7), demographics, threat and coping appraisals, perceived resilience (BRS), and specific coping behaviours (validated as part of this study). The relationship between responses and coping strategies was measured using tetrachoric correlations. Structural equation modelling was used to test the model. RESULTS: A model significantly fit our data (rel χ(2) = 2.05, RMSEA = 0.029 95%, CI (0.016, 0.042), CFI = 0.99, TLI = 0.98, SRMR = 0.014). Age and coping appraisal predicted anxiety and depression. Whereas, threat appraisal and ethnicity only predicted anxiety, and resilience only predicted depression. Additionally, specific coping behaviours predicted anxiety and depression, with overlap on distraction. CONCLUSIONS: Some, but not all, risk factors significantly predict anxiety and depression. While there is a relationship between anxiety and depression, different factors may put people at greater risk of one or the other during the pandemic

Space-time variations in child mortality in a rural South African population with high HIV prevalence (2000–2014)

Objective The aim of the study was to identify the key determinants of child mortality ‘hot-spots’ in space and time. Methods Comprehensive population-based mortality data collected between 2000 and 2014 by the Africa Centre Demographic Information System located in the UMkhanyakude District of KwaZulu-Natal Province, South Africa, was analysed. We assigned all mortality events and person-time of observation for children <5 years of age to an exact homestead of residence (mapped to <2m accuracy as part of the DSA platform). Using these exact locations, both the Kulldorff and Tango spatial scan statistics for regular and irregular shaped cluster detection were used to identify clusters of childhood mortality events in both space and time. Findings Of the 49 986 children aged 20 per 1000 person-years in 2001–2003 to 4 per 1000 person-years in 2014. The two scanning spatial techniques identified two high-risk clusters for child mortality along the eastern border of the study site near the national highway, with a relative risk of 2.10 and 1.91 respectively. Conclusions The high-risk communities detected in this work, and the differential risk factor profile of these communities, can assist public health professionals to identify similar populations in other parts of rural South Africa. Identifying child mortality hot-spots will potentially guide policy interventions in rural, resource-limited settings